Right care, right place, right time

Blue Cross and Blue Shield companies announce improvements to make health care safer, effective and more affordable

The mission of every Blue Cross and Blue Shield (BCBS) company is to help members access quality, affordable health care. To make that possible, we need a system to ensure resources are used appropriately. Prior authorization is a tool that balances different priorities so that patients receive the most effective care at the most affordable cost. The process confirms that treatments and services our members receive are covered, evidence-based and not redundant, ultimately ensuring that every health care dollar is spent wisely. It lowers out-of-pocket costs for our members and premiums for everyone. 

Many BCBS companies have reduced the scope of services subject to prior authorization in the past several years. The vast majority of claims don’t require prior authorization, but it’s a particularly important step for high-risk, high-cost care decisions. Still, we know the process is not perfect, so we are taking steps to improve it, with a focus on making prior authorization faster, more seamless and more streamlined. BCBS companies are partnering with AHIP and health insurance plans across the country on this broad pledge for an improved patient experience.

Here's our commitment to you:

Reducing prior authorizations:

BCBS companies routinely review their prior authorization requirements, and many have taken steps to reduce the volume of prior authorization requirements in recent years. We will build on these efforts and commit to reduce in-network prior authorization for medical services as appropriate for the local market each plan serves with demonstrated reductions by Jan. 1, 2026. 

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Fast-tracking responses for electronic requests:

Patients understandably want fast responses regarding prior authorization. In 2027, for all coverage types, BCBS companies commit to providing a response in near real time for at least 80% of electronic prior authorization requests for medical services that include all the necessary clinical documentation.

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Providing more personalized support and more transparency:

BCBS companies will work to ensure messages about prior authorization are clear and contain personalized information including what is needed to support approval, next steps and available appeal processes. We’re enhancing transparency by providing trained support staff to answer questions about documentation and guidance on the process. 

These efforts will be implemented by Jan. 1, 2026.

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A seamless process for people who switch health insurance companies:

If a member switches health insurance, BCBS companies want to ensure that care continues uninterrupted. When a patient has been approved for a service by one health insurance company, committed BCBS companies will honor the previous company’s prior authorization for 90 days—even if the plan is not from a BCBS company, as long as the service is a covered benefit under the new plan with an in-network provider. This change will take effect on Jan. 1, 2026.

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Medical experts, including doctors, lead prior authorization reviews:

Prior authorization helps ensure the treatments and services our members receive are covered, evidence-based and not duplicative. Decisions are guided by nationwide best practices for care, helping identify what has proven successful for members in the past. Existing and ongoing practice will ensure that a licensed and qualified clinician will personally review authorization requests that cannot be approved.

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“These measurable commitments – addressing improvements like timeliness, scope, and streamlining – mark a meaningful step forward in our work together to create a better system of health,” said Kim Keck, president and CEO, Blue Cross Blue Shield Association.

“This is an important foundation to address bigger problems together, at a time when technology and interoperability can deliver real improvements to patient experience.”

 

Giving doctors more time with patients, less time on paperwork:

The way to submit documents for the prior authorization process is not always consistent, which can create challenges for health care providers. BCBS companies will work toward implementing common, transparent submissions for electronic prior authorization, enabling faster decisions for patients. The goal is to have this standardized system available to BCBS companies and providers by Jan. 1, 2027. 

Improving the prior authorization process will help us create an efficient, affordable and sustainable health care system for everyone. Working together—across health insurers and with care providers—we can ensure a better balance of health care resources so that patients receive the most effective care at lower costs.

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More details about our commitment:

Consistent with state and federal requirements, these commitments are being made by BCBS plans that offer fully insured commercial coverage, Marketplace plans, and Medicare Advantage plans. BCBS companies will encourage self-funded customers to adopt the commitments as well.